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LAKE COUNTRY ENDOSCOPY CENTER, LLC
NPI 1184897472
Clinic/Center - Ambulatory Surgical in Oconomowoc, WI

Active since April 08, 2008CLIA 52D1090159 · Waiver
1185 CORPORATE CENTER DR, SUITE 125, OCONOMOWOC, WI 53066(414) 454-0600(414) 454-0971 Get Directions Write a Review

NPPES record last updated: January 8, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 8, 2025, Oct 25, 2020 (2 updates tracked since 2020).

About Lake Country Endoscopy Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE COUNTRY ENDOSCOPY CENTER, LLC (NPI 1184897472) is a healthcare organization registered as an ambulatory surgical in Oconomowoc, Wisconsin and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through October 2, 2026 and lists Bao Xiong Thao, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1184897472
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameLAKE COUNTRY ENDOSCOPY CENTER, LLC
Location Address1185 CORPORATE CENTER DR, SUITE 125Oconomowoc, WI 53066-4845
Mailing Address2801 W Kinnickinnic River Pkwy Ste 1080Milwaukee, WI 53215-3689 · (414) 908-6615 · Fax (414) 908-6634
Phone(414) 454-0600
Fax(414) 454-0971
Organization SubpartNo
Authorized OfficialBao Xiong ThaoAuthorized Official · (414) 908-6506
Enumeration DateApril 8, 2008
Last NPPES UpdateJanuary 8, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2025
✔ NPI 1184897472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1185 CORPORATE CENTER DR, Oconomowoc, WI 53066
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Other Identifiers 1

Medicaid1184897472WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Network Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D1090159

Lake Country Endoscopy Center · Oconomowoc, WI
Active · expires Oct 2, 2026
CLIA Number52D1090159
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateOctober 3, 2024
Certificate Expiration DateOctober 2, 2026
Laboratory DirectorDr. James T. Kwiatt
Laboratory Phone(414) 266-9209
Laboratory LocationLake Country Endoscopy Center1185 Corporate Center Dr Ste 125, Oconomowoc, WI 53066
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
231 services229 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
168 services166 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
151 services149 patients
Colorectal cancer screening; colonoscopy on individual at high risk G0105
Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.
102 services102 patients
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121
Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.
43 services43 patients
Dilation of esophagus 43450
Dilation of the esophagus is a procedure aimed to stretch or open up your esophagus (the tube connecting your mouth to your stomach) when it's narrow. It helps to improve swallowing and alleviate discomfort. It's typically performed using a flexible tube or balloon, under sedation.
29 services29 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALISHA F MELL OT
Occupational Therapist
1185 CORPORATE CENTER DR, SUITE 155
OCONOMOWOC, WI 53066
Waukesha County (262) 567-5385
SARAH JEAN SANFORD-SMITH MSN FNP-C
Nurse Practitioner (Family)
1185 CORPORATE CENTER DR
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8400
BRETT A. LINZER M.D.
Internal Medicine
1185 CORPORATE CENTER DR, PROHEALTH CARE MEDICAL ASSOCIATES, INC.
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8400
FIRAS GHANEM M.D.
Internal Medicine (Cardiovascular Disease)
1185 CORPORATE CENTER DR
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8800
LAUREN S OLSON APRN
Nurse Practitioner (Family)
1185 CORPORATE CENTER DR
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8484
JOAN ELIZABETH SHELLEY N.P.
Nurse Practitioner (Adult Health)
1185 CORPORATE CENTER DR, SUITE 300
OCONOMOWOC, WI 53066
Waukesha County (262) 567-5190
JAMES MITCHELL POWELL DC
Chiropractor
1185 CORPORATE CENTER DR
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8411
ERIC P CONRADSON M.D.
Internal Medicine
1185 CORPORATE CENTER DR, SUITE 175
OCONOMOWOC, WI 53066
Waukesha County (262) 928-8400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Country Endoscopy Center, LLC's NPI number?

The NPI number for Lake Country Endoscopy Center, LLC is 1184897472. It was assigned to this organization in the NPPES registry on April 8, 2008.

Where is Lake Country Endoscopy Center, LLC located?

Lake Country Endoscopy Center, LLC is located at 1185 Corporate Center Dr Suite 125, Oconomowoc, WI 53066. The listed phone number is (414) 454-0600.

What is Lake Country Endoscopy Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Lake Country Endoscopy Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D1090159) is associated with this NPI, valid through October 2, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lake Country Endoscopy Center, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Network Health, Quartz and UnitedHealthcare list Lake Country Endoscopy Center, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lake Country Endoscopy Center, LLC was last updated on January 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.